Speech disorders or speech impediments are a type of communication disorders where 'normal' speech
is disrupted. This can mean stuttering, lisps, etc. Someone who is unable to speak due to a speech disorder
is considered mute.
Classifying speech into normal and disordered is more problematic than it first seems. By a strict
classification, only 5% to 10% of the population has a completely normal manner of speaking (with
respect to all parameters) and healthy voice; all others suffer from one disorder or another.
Stuttering affects approximately 1% of the adult population.
Cluttering, a speech disorder that has similarities to stuttering.
Dysprosody is the rarest neurological speech disorder. It is characterized by alterations in
intensity, in the timing of utterance segments, and in rhythm, cadence, and intonation of words.
The changes to the duration, the fundamental frequency, and the intensity of tonic and atonic
syllables of the sentences spoken, deprive an individual's particular speech of its characteristics.
The cause of dysprosody is usually associated with neurological pathologies such as brain
vascular accidents, cranioencephalic traumatisms, and brain tumors.
Muteness is complete inability to speak
Speech sound disorders involve difficulty in producing specific speech sounds (most often certain
consonants, such as /s/ or /r/), and are subdivided into articulation disorders (also called phonetic
disorders) and phonemic disorders. Articulation disorders are characterized by difficulty learning
to produce sounds physically. Phonemic disorders are characterized by difficulty in learning the
sound distinctions of a language, so that one sound may be used in place of many. However, it is
not uncommon for a single person to have a mixed speech sound disorder with both phonemic
and phonetic components.
Voice disorders are impairments, often physical, that involve the function of the larynx or vocal
Dysarthria is a weakness or paralysis of speech muscles caused by damage to the nerves and/or
brain. Dysarthria is often caused by strokes, Parkinsons disease, ALS, head or neck injuries,
surgical accident, or cerebral palsy.
Apraxia of speech may result from stroke or be developmental, and involves inconsistent
production of speech sounds and rearranging of sounds in a word ("potato" may become "topato"
and next "totapo"). Production of words becomes more difficult with effort, but common phrases
may sometimes be spoken spontaneously without effort. It is now considered unlikely that
childhood apraxia of speech and acquired apraxia of speech are the same thing, though they share
There are three different levels of classification when determining the magnitude and type of a speech
disorder and the proper treatment or therapy:
1. Sounds the patient can produce
a) Phonemic- can be produced easily; used meaningfully and contrastively
b) Phonetic- produced only upon request; not used consistently, meaningfully, or
contrastively; not used in connected speech
2. Stimulable sounds
a) Easily stimulable
b) Stimulable after demonstration and probing (i.e. with a tongue depressor)
3. Cannot produce the sound
a) Cannot be produced voluntarily
b) No production ever observed
In many cases the cause is unknown. However, there are various known causes of speech impediments,
such as "hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical
impairments such as Cleft lip and palate, and vocal abuse or misuse." Child abuse may also be a cause in
Many of these types of disorders can be treated by speech therapy, but others require medical attention by
a doctor in phoniatrics. Other treatments include correction of organic conditions and psychotherapy.
In the United States, school-age children with a speech disorder are often placed in special education
programs. Children who struggle to learn to talk often experience persistent communication difficulties in
addition to academic struggles. More than 700,000 of the students served in the public schools’ special
education programs in the 2000-2001 school year were categorized as having a speech or language
impediment. This estimate does not include children who have speech and language impairments
secondary to other conditions such as deafness". Many school districts provide the students with speech
therapy during school hours, although extended day and summer services may be appropriate under
Patients will be treated in teams, depending on the type of disorder they have. A team can include SLPs,
specialists, family doctors, teachers and family members.
Suffering from a speech disorder can have negative social effects, especially among young children.
Those with a speech disorder can be targets of bullying because of their disorder. The bullying can result
in decreased self-esteem. Later in life, bullying is experienced less by a general population, as people
become more understanding as they age.
Speech Disorders and Language Disorders
A speech disorder refers to a problem with the actual production of sounds, whereas a language disorder
refers to a difficulty understanding or putting words together to communicate ideas.
Speech disorders include:
Articulation disorders: difficulties producing sounds in syllables or saying words incorrectly to
the point that listeners can't understand what's being said.
Fluency disorders: problems such as stuttering, in which the flow of speech is interrupted by
abnormal stoppages, repetitions (st-st-stuttering), or prolonging sounds and syllables
Resonance or voice disorders: problems with the pitch, volume, or quality of the voice that
distract listeners from what's being said. These types of disorders may also cause pain or
discomfort for a child when speaking.
Dysphagia/oral feeding disorders: these include difficulties with drooling, eating, and
Language disorders can be either receptive or expressive:
Receptive disorders: difficulties understanding or processing language.
Expressive disorders: difficulty putting words together, limited vocabulary, or inability to use
language in a socially appropriate way.
Specialists in Speech-Language Therapy
Speech-language pathologists (SLPs), often informally known as speech therapists, are professionals
educated in the study of human communication, its development, and its disorders. They hold at least a
master's degree and state certification/licensure in the field, and a certificate of clinical competency from
the American Speech-Language-Hearing Association (ASHA).
SLPs assess speech, language, cognitive-communication, and oral/feeding/swallowing skills to identify
types of communication problems (articulation; fluency; voice; receptive and expressive language
disorders, etc.) and the best way to treat them.
In speech-language therapy, an SLP will work with a child one-on-one, in a small group, or directly in a
classroom to overcome difficulties involved with a specific disorder.
Therapists use a variety of strategies, including:
Language intervention activities: The SLP will interact with a child by playing and talking,
using pictures, books, objects, or ongoing events to stimulate language development. The
therapist may also model correct pronunciation and use repetition exercises to build speech and
Articulation therapy: Articulation, or sound production, exercises involve having the therapist
model correct sounds and syllables for a child, often during play activities. The level of play is
age-appropriate and related to the child's specific needs. The SLP will physically show the child
how to make certain sounds, such as the "r" sound, and may demonstrate how to move the tongue
to produce specific sounds.
Oral-motor/feeding and swallowing therapy: The SLP will use a variety of oral exercises —
including facial massage and various tongue, lip, and jaw exercises — to strengthen the muscles
of the mouth. The SLP also may work with different food textures and temperatures to increase a
child's oral awareness during eating and swallowing.
When Is Therapy Needed?
Kids might need speech-language therapy for a variety of reasons, including:
cognitive (intellectual, thinking) or other developmental delays
weak oral muscles
birth defects such as cleft lip or cleft palate
motor planning problems
respiratory problems (breathing disorders)
feeding and swallowing disorders
traumatic brain injury
Therapy should begin as soon as possible. Children enrolled in therapy early (before they're 5 years old)
tend to have better outcomes than those who begin therapy later.
This does not mean that older kids can't make progress in therapy; they may progress at a slower rate
because they often have learned patterns that need to be changed.
Finding a Therapist
It's important to make sure that the speech-language therapist is certified by ASHA. That certification
means the SLP has at least a master's degree in the field and has passed a national examination and
successfully completed a supervised clinical fellowship.
Sometimes, speech assistants (who usually have a 2-year associate's or 4-year bachelor's degree) may
assist with speech-language services under the supervision of ASHA-certified SLPs. Your child's SLP
should be licensed in your state and have experience working with kids and your child's specific disorder.
You might find a specialist by asking your child's doctor or teacher for a referral or by checking local
directories online or in your telephone book. State associations for speech-language pathology and
audiology also maintain listings of licensed and certified therapists.